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THE ROTARY FOUNDATION
CONTRIBUTION FORM

Contributions can also be made at rotary.org/donate.
1. DONOR OF CONTRIBUTION
Type of Donor (Check one): Individual Rotary club Rotaract club District Business
Charitable organization/Foundation Other:
Name: Donor ID:
Club Name: Club No.: District No.:
Billing Address: City: State/Province:
Country: Postal Code:
Daytime Phone: Email Address:
2. DESIGNATION/PURPOSE (Check one):
 Annual Fund — SHARE  Eradicating polio  Promoting peace  Endowment -
 Fighting disease  Providing clean water  Saving mothers and children  Global Grant #
 Supporting education  Growing local economies  Responding to disasters  Other
3. CONTRIBUTION DETAILS
Amount of contribution Currency
Type of Payment (Check one): For security purposes, please do not send credit card contributions via email.
 Credit card:  Visa  MasterCard  Diners Club  JCB  American Express
Make this a recurring contribution:  Monthly  Quarterly  Annually (Select month)
Card Number
Expiration Date: CVN*:
Name as it appears on credit card: Signature:
 Check — Payable to “The Rotary Foundation.” Check number
 Wire transfer Date initiated (Please send completed contribution form as soon as possible after initiating a wire transfer.)
*The card verification number, or CVN, is a three-digit number that appears on the back of your credit or debit card; for AmEx, it is a four-digit number on the front of the card. It typically appears following the digits of
your credit card number.
4. SHIPPING INFORMATION — Recognition materials only
If recognition materials from this contribution are requested for individual(s) other than donor, please complete the Paul Harris Fellow Recognition Transfer
Request Form.
Presentation Date:  Please do not send recognition  Please keep my gift anonymous
Send recognition to (Check one; if left blank, recognition will be sent to club president):
 Club President  Club Secretary  Club Treasurer  Club Foundation Chair  Other, record information below
Name: Address:
City, State/Prov.: Country, Postal Code:
Daytime Phone: Email Address:
5. INDIVIDUAL COMPLETING THIS FORM (if other than donor)
Name: Daytime Phone:
Email Address: Date:
Please send your completed form with contribution only once.
Data privacy is important to Rotary International and The Rotary Foundation (collectively, “Rotary”) and the personal data shared with Rotary will only be used for
official Rotary business to support Rotary’s core business purposes. Personal data collected on this form is subject to Rotary’s Privacy Policy found at my.rotary.org/
en/privacy-policy.
Mail: The Rotary Foundation, 14280 Collections Center Drive, Chicago, IL 60693, USA (Canada: The Rotary Foundation (Canada) c/o 911600, P.O. Box 4090 STN A,
Toronto, ON M5W 0E9, Canada). Email: rotarysupportcenter@rotary.org. Fax: +1-847-328-5260. For more information, or to make a contribution by phone:
1-866-9ROTARY (1-866-976-8279). Or contact the Rotary International office that serves your area. The contribution amount may not include the value of any
goods or services given to an individual donor in consideration for this contribution.

70 Rotary District 3201 - Presidents & Secretaries Manual 2021